After Action Review

An after action review (AAR) is a qualitative review of actions taken to respond to an emergency as a means of identifying best practices, gaps and lessons learned. Following an emergency response to a public health event, an AAR seeks to identify what worked well or not and how these practices can be maintained, improved, institutionalized and shared with relevant stakeholders.

Organisational learning requires continuous assessment of performance, looking at successes and challenges and ensuring that learning takes place to support continuous improvement. The After Action Review (AAR) is a simple methodology for facilitating this assessment. It works by bringing together a team to discuss a task, event, activity or project, in an open and honest environment.

The systematic application of properly conducted AARs across an organization, or between organisations, can help to drive improvement, as well as, turn tacit knowledge into learning and build trust among team members. When applied correctly, AARs can become a key aspect of the internal system of learning and motivation, and should be part of all emergency management programmes.

The objectives of an AAR are to:

  • Demonstrate the functional capacity of existing systems to prevent, detect, and respond to a public health event;
  • Identify lessons to develop practical, actionable steps for improving existing systems;
  • Identify areas that may benefit from added technical assistance or to refine capacity building efforts to address real-life challenges ;
  • Disseminate/share lessons learned from the review with other public health professionals; and
  • Provide documented evidence to support advocacy for resource mobilization.

After action review calendar

Upcoming

AR
1 January 2019 to 30 January 2019
Tunisia Jan.2019

Benefits of conducting an after action review

  • Team members can immediately apply lessons learned: Because AARs are held soon after an event with broad participation, they enable quick identification of lessons learned that can be applied to the next event immediately. Lesson learnt from AARs can also be applied for long term planning and mid- term evaluations;
  • Critical thinking around the event: AARs are often led by external facilitators who were uninvolved in the event and who ask the “why” questions that help pinpoint the root causes. The process helps team members to take a step back from their direct involvement and reflect on what happened more critically;
  • Peer learning: External facilitators may also be peers from related sectors, such as the animal health departments or hospital management boards. This can result in additional lessons learned across sectors.
  • Mutual accountability: The sharing of AAR results can reassure the global public health community that commitments to IHR are strong and that measures are being taken to address identified gaps. Furthermore, the sharing of lessons identified may also benefit other countries facing similar challenges or hazards and may also provide a basis for follow-on support and funding.

Scope of an after action review

After action reviews can assess all functions of a country’s management of the emergency or identify specific functions to ensure focused discussion around high priority learning opportunities. The scope of the AAR will be determined largely by the nature and magnitude of the event being assessed, and the perceived learning opportunities.

A clearly defined scope and objectives will drive the preparation of tools for conducting the AAR, and determine the format and learning outcomes that can be expected. 

Timing and frequency of after action reviews

Ideally, a national level AAR should be conducted after the end of all events, as the AAR is an important element of a culture of a continuous learning and improvement. Notwithstanding this, for the purposes of the IHR MEF an AAR should be conducted at least annually, if an event occurs that is appropriate for review. It should be noted that the same methodology can be applied to response actions while an event is still ongoing as a form of real-time evaluation or when the response has moved to a different phase (e.g., emergency response to recovery). In this case, however AAR planners should take care not to obstruct any response operations.

Format of an after action review

In general, one of the defining features of an AAR is that it is involves collective critical analyses of the response actions in order to identify best practises, lessons and challenges. For this reason, the suggested format will include facilitated discussion of relevant participants. Nevertheless, this may include different formats. Choosing the right format is critical to achieving the desired outcomes. Smaller scope AARs, or a review that focus on a single response function, can be conducted as a facilitated discussion with members of the team responsible for this function. For wider scope reviews, which may include multiple functions or the participation of different levels of government or sectors, a larger workshop format with facilitated discussions is required. In Member States where group work is not conducive to critical analyses, the AAR can be implemented as a series of interviews with individuals or small groups. Each format has its own value and a combination can also be employed to achieve desired results.

Logic of an after action review

The simplicity of AAR is its strength. Essentially, the logical sequence of how to generate and capture feedback from participants in all AAR forms follows the same basic sequence:

1.       Document: Establish how actions actually were implemented in contrast to how they were supposed to or normally happen, according to plans.

2.       Identify and analyse: Compare and understand the difference and identify what worked and what did not work. Identify the root causes that led to success or failure.

3.       Improve: Identify actions to strengthen or improve performance

Selection of events for after action review

Countries should conduct AARs for all types of hazards described in the IHR (2005)[1], as well as for natural and man-made disasters. Events for which an AAR should be conducted could include:
  • Public health emergencies of international concern (PHEIC)
  • Events of substantiated or potential international concern
  • Events with health consequences or with strategic or tactical complexity, such as:
  • Health events during national or international mass gatherings 
  • Events associated with chemical or radiation-related hazards that have, or which have the potential to have, health consequences
  • Events affecting multiple countries
  • Any event of particular importance to a ministry of health

[1] IHR hazards include infectious disease, chemical and radiological-related hazards, and food safety.

After action review activities

Region Country Dates Status Objective Report
African Region Nigeria Planned Cholera
African Region Cabo Verde Planned
Eastern Mediterranean Region Kuwait Planned
African Region Zambia Planned
European Region Serbia Planned West Nile 2019
Eastern Mediterranean Region Tunisia 1 January 2019 to 30 January 2019 Planned Flooding
African Region Zimbabwe Planned
Eastern Mediterranean Region Libya Planned
Eastern Mediterranean Region Kuwait Planned
African Region Nigeria 21 August 2017 to 22 August 2017 Conducted Lassa fever AAR
South-East Asia Region Myanmar 15 October 2017 Conducted H1N1
Western Pacific Region Lao People's Democratic Republic 1 December 2017 to 30 December 2017 Conducted Dengue
South-East Asia Region Bangladesh Planned
Eastern Mediterranean Region Iran (Islamic Republic of) 18 August 2018 to 19 August 2018 Conducted
South-East Asia Region India Planned
African Region Nigeria 13 August 2018 to 15 August 2018 Conducted
African Region South Africa 19 November 2018 to 21 November 2018 Planned Listeriosis
African Region Cabo Verde 1 October 2018 to 5 October 2018 Conducted Cape Verde - Malaria
African Region Nigeria 2 July 2018 to 4 July 2018 Conducted Monkeypox
African Region Nigeria 28 May 2018 to 31 May 2018 Conducted Cholera
African Region Benin 17 July 2018 to 20 July 2018 Conducted Lassa fever AAR
African Region Burkina Faso 16 April 2018 to 19 April 2018 Conducted Dengue AAR
Western Pacific Region Viet Nam 14 December 2016 Conducted Zika Virus Disease AAR
Western Pacific Region Lao People's Democratic Republic 25 January 2016 to 29 January 2016 Conducted cVDPV AAR 25-29 Jan, 23 May-10 June and 15-19 August
Western Pacific Region Lao People's Democratic Republic 26 October 2016 to 27 October 2016 Conducted Avian Influenza H5N1 AAR
Western Pacific Region Cambodia 8 July 2016 Conducted Avian Influenza H5N1 AAR
Western Pacific Region Cambodia 15 March 2016 Conducted Foodborne disease outbreak AAR
Western Pacific Region Viet Nam 1 September 2017 to 31 October 2017 Conducted Dengue AAR
South-East Asia Region Maldives 18 September 2017 to 22 September 2017 Conducted H1N1 AAR
Western Pacific Region Lao People's Democratic Republic 25 December 2017 to 27 December 2017 Conducted Hepatitis A AAR
Western Pacific Region Cambodia 23 March 2017 Conducted Methanol poisoning AAR
African Region Madagascar 2 July 2018 to 6 July 2018 Conducted Madagascar – Plague PDF icon RT Madagascar20_09_2018.pdf
European Region Romania 12 March 2018 to 15 March 2018 Conducted
Eastern Mediterranean Region Sudan Planned Sudan - Dengue
Eastern Mediterranean Region Pakistan 14 May 2018 to 16 May 2018 Conducted Pakistan - Dengue
African Region Senegal 5 March 2018 to 9 March 2018 Conducted Senegal - Dengue
African Region Rwanda Planned Rwanda - Typhoid
African Region Democratic Republic of Congo Planned Democratic Republic of the Congo - Ebola
African Region Cote d'Ivoire Planned Côte d’Ivoire - Dengue
African Region Chad 23 July 2018 to 27 July 2018 Conducted Chad - Hepatitis E
African Region Cabo Verde Planned Cape Verde - Zika
African Region Burundi 9 April 2018 to 14 April 2018 Conducted Malaria AAR
Eastern Mediterranean Region Morocco 23 January 2018 to 26 January 2018 Conducted Brucellosis AAR
African Region Uganda 5 March 2018 to 9 March 2018 Conducted Marburg AAR
African Region Togo 24 October 2017 to 27 October 2017 Conducted Lassa fever and Meningitis AAR
African Region Sierra Leone 1 September 2017 to 30 September 2017 Conducted Landslide AAR
African Region Nigeria 4 June 2018 to 7 June 2018 Conducted Lassa fever AAR
African Region Niger 20 November 2017 to 24 November 2017 Conducted Rift Valley fever AAR
European Region Netherlands 11 July 2017 Conducted Polio AAR
African Region Namibia 11 December 2017 to 15 December 2017 Conducted Crimean Congo haemorrhagic fever AAR
African Region Mozambique 24 July 2017 to 28 July 2017 Conducted Cholera AAR
African Region Mauritania 18 September 2017 to 22 September 2017 Conducted Crimean Congo haemorrhagic fever AAR
European Region Iceland 4 July 2017 Conducted Gastro intestinal illness AAR
African Region Central African Republic 13 November 2017 to 17 November 2017 Conducted Cholera AAR
Western Pacific Region Cambodia 11 December 2017 to 15 December 2017 Conducted Trichinellosis AAR
African Region Benin 10 July 2017 to 14 July 2017 Conducted Lassa fever AAR
African Region Angola 20 November 2017 to 24 November 2017 Conducted Yellow fever AAR
African Region Burkina Faso 13 February 2017 to 15 February 2017 Conducted Burkina Faso – Dengue
African Region United Republic of Tanzania 14 August 2017 to 18 August 2017 Conducted Tanzania AAR Cholera